Impact of Impella 5.5 therapy duration on the incidence of stroke in prolonged mechanical circulatory support
Presented During: Welcome Reception and Poster Competition | Sponsored by: TransMedics
Houston Methodist
Osaka, ON
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Therese Hoof is a fourth year General Surgery Resident at Houston Methodist Hospital.
Friday, September 20, 2024: 5:00 PM - 6:30 PM
Omni King Edward Hotel
Description
Objective: The objective of this study was to investigate the relationship between the duration of Impella 5.5 therapy and the risk of stroke in patients with severe heart failure requiring mechanical circulatory support.
Methods: A retrospective cohort study was conducted including all consecutive patients who received Impella 5.5 support between February 2020 and March 2024 at our institution. Data on patient demographics, duration of Impella therapy, incidence of stroke during or outside of mechanical circulatory support, and other relevant clinical variables were collected from electronic health records. The primary outcome was the incidence of stroke during Impella 5.5 therapy, with duration of therapy categorized into four groups for analysis.
Results: A total of 145 patients (mean age 57.7, 88% male) were included in the analysis. 25 patients (17.2%) experienced a stroke during the study period, 15 of which (10%) happened during Impella 5.5 support. The median duration of therapy was 24 days (IQR 12-51 days).
Incidence of stroke during Impella 5.5 therapy was 4.5% for group 1 (0-7 days), 4.2% for group 2 (8-14 days), 4.5% for group 3 (15-21 days) and 16% for group 4 (>21 days). The difference in stroke incidence between patients who received Impella support for less than 21 days and those who received it for longer than 21 days was statistically significant (p=0.05).
Conclusions: Prolonged therapy with the Impella 5.5 is associated with a higher risk of stroke in patients with severe heart failure. Clinicians should consider this risk when determining the duration of mechanical circulatory support with the Impella 5.5 and evaluating weaning strategies. Protocols to mitigate the risk of stroke, such as careful patient selection, monitoring, and potentially earlier device removal when feasible, should be explored in future studies to optimize outcomes for these critically ill patients.
Authors
Tommaso Cambiaghi (1), Therese Hoof (1), Fatima Qamar (1), Memhet Akay (1)
Institutions
(1) Houston Methodist, Houston, TX
Methods: A retrospective cohort study was conducted including all consecutive patients who received Impella 5.5 support between February 2020 and March 2024 at our institution. Data on patient demographics, duration of Impella therapy, incidence of stroke during or outside of mechanical circulatory support, and other relevant clinical variables were collected from electronic health records. The primary outcome was the incidence of stroke during Impella 5.5 therapy, with duration of therapy categorized into four groups for analysis.
Results: A total of 145 patients (mean age 57.7, 88% male) were included in the analysis. 25 patients (17.2%) experienced a stroke during the study period, 15 of which (10%) happened during Impella 5.5 support. The median duration of therapy was 24 days (IQR 12-51 days).
Incidence of stroke during Impella 5.5 therapy was 4.5% for group 1 (0-7 days), 4.2% for group 2 (8-14 days), 4.5% for group 3 (15-21 days) and 16% for group 4 (>21 days). The difference in stroke incidence between patients who received Impella support for less than 21 days and those who received it for longer than 21 days was statistically significant (p=0.05).
Conclusions: Prolonged therapy with the Impella 5.5 is associated with a higher risk of stroke in patients with severe heart failure. Clinicians should consider this risk when determining the duration of mechanical circulatory support with the Impella 5.5 and evaluating weaning strategies. Protocols to mitigate the risk of stroke, such as careful patient selection, monitoring, and potentially earlier device removal when feasible, should be explored in future studies to optimize outcomes for these critically ill patients.
Authors
Tommaso Cambiaghi (1), Therese Hoof (1), Fatima Qamar (1), Memhet Akay (1)
Institutions
(1) Houston Methodist, Houston, TX